Provider Demographics
NPI:1366941650
Name:FEUERBORN, TYLER (APRN-C)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:FEUERBORN
Suffix:
Gender:M
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BUCKNER BLVD STE 141
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1794
Mailing Address - Country:US
Mailing Address - Phone:214-974-9126
Mailing Address - Fax:469-574-0383
Practice Address - Street 1:1515 S BUCKNER BLVD STE 141
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1794
Practice Address - Country:US
Practice Address - Phone:214-974-9126
Practice Address - Fax:469-574-0383
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9407120363LA2200X
FLAPRN9407120363LP2300X
TX1061932363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105715700Medicaid